子宫动脉栓塞联合病灶切除术治疗剖宫产瘢痕妊娠效果及其影响因素

Study on the Efficiency of Uterine Artery Embolization Combined with Lesionectomy in the Treatment Process of Cesarean Scar Pregnancy and Analysis of Its Influencing Factors

目的探讨子宫动脉栓塞术联合病灶切除术治疗剖宫产瘢痕妊娠效果及其影响因素。方法回顾性分析我院2016年3月至2018年3月收治的120例剖宫产瘢痕妊娠患者的临床病历资料。其中60例患者接受子宫动脉栓塞术联合清宫术进行治疗(对照组),60例患者接受子宫动脉栓塞术联合病灶切除术进行治疗(观察组)。观察并比较两组患者的治疗效果,根据患者治疗是否有效,将其分为有效组(n=88)与无效组(n=32),并通过Logistic回归模型分析影响患者疗效的影响因素。结果(1)治疗前,两组病灶直径、子宫下段肌层部位厚度、阻力指数、人绒毛膜促性腺激素(β-HCG)差异均无统计学意义(P均>0.05)。治疗后,观察组病灶直径、β-HCG均低于对照组(P均<0.05),而子宫下段肌层部位厚度、阻力指数较对照组均增加(P均<0.05);(2)治疗前,两组躯体疼痛、生理职能、睡眠质量、认知功能、精力等生活质量评分值差异均无统计学意义(P均>0.05)。治疗后,观察组上述指标值均高于对照组(P均>0.05);(3)观察组术中出血量、住院时间、月经复潮时间、病灶缩小时间、血β-HCG恢复时间均低于对照组(P均<0.05);(4)观察组治疗总有效率(83.33%)高于对照组(63.33%)(P<0.05),观察组不良反应发生率低于对照组(P<0.05);(5)Logistic回归分析结果表明,孕周数、孕囊体积、瘢痕妊娠类型均为影响患者治疗效果的影响因素。结论子宫动脉栓塞术联合病灶切除术治疗剖宫产瘢痕妊娠,疗效好且安全。孕周数、孕囊体积、瘢痕妊娠类型均为患者治疗效果的影响因素。

Objective To study on the efficiency of uterine artery embolization combined with lesionectomy in the treatment process of cesarean scar pregnancy and its influencing factors.Methods The 120 patients with cesarean scar pregnancy in our hospital from March 2016 to March 2018 were selected for study.They were considered as study objects and the clinical data were analyzed retrospectively.They were divided into observation group(n=60)and control group(n=60).The patients were treated with uterine artery embolization and lesionectomy in the observation group,while the patients were treated with uterine artery embolization and uterine curettage in the control group.The treatment effects were observed and compared.At the same time,according to whether the patient's treatment was effective or not,they were divided into efficiency group(n=88)and non-efficiency group(n=32),and the risk of prognostic factors were analyzed by Logistic regression model.Results(1)Before treatment,there were no obvious difference about lesion diameter,thickness of lower uterine muscle layer,resistance index,β-HCG between these two groups(P all>0.05).After treatment,the index including lesion diameter andβ-HCG were significantly lower in observation group compared with the control group(P all<0.05),while the thickness of lower uterine muscle layer and resistance index in observation group was higher than that of control group(P all<0.05).(2)Before treatment,there was no significant difference in the score of life quality including body pain,physiological functions,sleep quality,cognitive function,and energy between the two groups of patients(P all>0.05).After treatment,the values of the above indicators in the observation group were significantly higher than those in the control group(P all<0.05).(3)It was significantly lower for the patients in the observation group about intraoperative blood loss,length of staying hospital,menstrual rejuvenation time,lesion shrinkage time,and bloodβ-HCG recovery time than those in the control group(P all<0.05).(4)The effective rate in the observation group(83.33%)was significantly higher than the control group(63.33%)(P<0.05),while the adverse effect in the observation group was lower than the control group(P<0.05).(5)According to Logistic regression analysis,it showed the influencing factors included gestational weeks,gestational sac volume,scar pregnancy type.Conclusion Uterine artery embolization combined with lesionectomy is used in the treatment process of cesarean scar pregnancy,and the treatment is effective and safe.In addition,preventive measures should be taken in time to improve the efficiency according to gestational weeks,gestational sac volume,scar pregnancy type.